Sunday, June 12, 2011

So two weeks ago, when i arrived at school this session, my mother sent me a message telling me my aunt was in the hospital and that she was flying to toronto and then taking the bus down to see her with my cousin the following week.

Over the last two weeks I found out that it was unlikely my aunt was going to be leaving the hospital. i knew i had to go.

after my classes ended, i flew to new york and then took a bus up into canada where i met up with my mom, my cousin and my uncle and his grand-daughter and we all went to the hospital to see my aunt. to say good-bye.

i never grew up with this family.

from the time i was three, the story goes, i had a bag packed and under my bed ready to go and visit family, my dad's family. the first time i took the greyhound alone i was three. i traveled all around saskatchewan between my ukrainian family, my aunts, and my cousins.

a few years ago at a family reunion, one of my cousins called me the black sheep of the family. i never really fit in and he called me on it. i loved growing up in a family that really did have so much culture to embrace, but most of my dad's side of the family are conservative farmers. home grown, salt of the earth kind of people. they are good people, and it was a good family to grow up in. my cousin's "accusation" though, was so true.

sitting around my aunts hospital bed with family that i've only really come to know in adulthood was a revelation. this is why i am who i am.

dark. sardonic. we joked about my aunts death and who was going to be the next one. there are bets. it was like a black episode of the odd couple. i fit in, without missing a beat. there is no question of nature vs. nurture here. my irish catholic heritage runs strong in my blood.

it was a long journey to get to my aunts side and i am at risk of not being allowed back in the country. my aunt may get out of the hospital. she talks as though she will, but she has congestive heart failure and only has 5% of her lung capacity left and from what i understand, thats the beginning of it. the hospital isn't doing much for her. her sheets were filthy. so after 16 hours of travel, i changed them so she could lay in a clean bed and i placed the compression socks that she was wearing on her legs the right way. two very small insignificant acts, but if i could do anything for my aunt the last time i was ever going to see her, anything to make her more comfortable. i would.

it wasn't a sad day. there were lots of laughs. lots of stories of their childhood. i'm glad i made it for this. i'm glad the i am meeting the family and getting to know them. understanding where it is i come from.

Wednesday, June 8, 2011

We can easily talk about birth positions in a purely mechanical sense. There are a limited variety of positions in which a woman can physiologically give birth: upright, squatting, hands-and-knees, or lithotomy/semi-recumbent. Throughout time and space, we have seen women give birth in any combination and spectrum of these positions. Each, one can argue, serves a purpose. But to look at birth positions culturally and apply it to how “we,” as women, birth today and how this may affect our daughters and grand-daughters, requires a deeper understanding of why we birth the way we do.

Feminist critiques on the state of modern birth focus on how the transference of birth out of the home and into the hospital has medicalised the event and removed a woman’s agency to direct her birth experience. While being true to an extent, it does not allow for the influence of our social constructs of gender identity and how we, as women, have been ingrained to birth.

Rational, selfless, caring, polite, and kind.

Or

Screaming, yelling, self-centered, and demanding of pain-relief.

Which is an accurate portrayal of women birthing today in the United States?

The media would lead us to believe that the latter is more common however, Martin (2003) has argued that we have internalized our roles as women to such a degree that even in the throes of childbirth, many women are more concerned about those around them than they are about themselves. We have internalized our gender roles so deeply that we birth in “gendered ways from within” (Martin 2003).

Childbirth classes teach women methods of self-control and relaxation. Martin (2003) argues that the Bradley Method, teaches us that when we get to a point where we cannot take it any longer, our partner, our husband, the father, is our protector and will show us how to birth, and give us the strength to birth.

Understanding the way we birth, in the context of a technology of gender,[i] helps us to understand why so many women do not “ask what they need while giving birth, and/or … put themselves at the center of the birth experience” (Martin 2003). Martin argues that

“[w]hen these gendered technologies broke down, usually during the most exhausting and painful parts of labor, these women said that they felt bad about their behavior, and they often apologized for it. Furthermore, in the end, some of these women did not value their own lived experiences and found their husbands' or doctors' views of the birth more "real" than their own.”

Robbie Davis-Floyd (1987), in her essays on “The Technological Mode of Birth,” identifies that 54% of women seem happy about their birth experiences in hospitals. They are more comfortable with the interventions and, she argues, American women may even feel slighted out of their birth-right if they were not given access to the technologically prescribed modes of childbirth (see below).

This ideology that birth “happens to us” is prescribed by our embedded, gendered experience of childbirth. We enter the hospital to be sick, to be taken care of. Childbirth has become an illness to be treated.

Cultural Patterns in Childbirth

The above is an introduction to how we, as women, birth in hospitals today. There are, however, some generalizations that can be made around birth itself. The following is an observation made by Simmons (1952) from a cross-cultural comparative study on childbirth:

“1. All peoples everywhere tend to regard birth as a significant biological event and ritualize it somewhat accordingly.

2. All peoples recognize certain critical psychological implications for childbirth. Primitive people tend to stress the psychosocial even more than the physical, while we do the reverse. We moderns are waking up, however, and perhaps we can learn a great deal from our primitive contemporaries.

3. The psychosocial factors of birth are under better-almost automatic- regulation in stable societies with slowly changing cultural patterns.

4. Babies are amazingly malleable and adaptive in almost any set of consistent, stable cultural patterns.”

A woman entering a hospital today undergoes a ritual. Robbie Davis-Floyd (1987), in her definitive essay on “The Technological Model of Birth,” describes this ritual initiation as it occurred in an American hospital in 1987.:

Shortly after entry into the hospital, the laboring woman will be symbolically stripped of her individuality, her autonomy, and her sexuality as she is "prepped"-a multistep procedure in which she is separated from her husband, her clothes are removed, she is dressed in a hospital gown and tagged with an ID bracelet, her pubic hair is shaved or clipped (returning her body to a conceptual state of childishness), and she is ritually cleansed with an enema. Now marked as institutional property, she may be reunited with her husband, if he chooses to be present, and put to bed. Her access to food will be limited or prohibited, and an intravenous needle may be inserted in her hand or arm. Symbolically speaking, the IV constitutes her umbilical cord to the hospital, signifying her now-total dependence on the institution for her life, telling her not that she gives life, but rather that the institution does. The laboring woman's cervix will be checked for degree of dilation, at least once every two hours and sometimes more often. If dilation is not progressing in conformity with standard labor charts, pitocin will be added to the intravenous solution to speed her labor (80% of the women in my study group were given pitocin, or "pitted"). This "labor augmentation" indicates to the woman that her machine is defective, as it is not producing on schedule, in conformity with production timetables (labor time charts). The administration of analgesia and/or anesthesia further demonstrates to her the mechanicity of her labor; epidural anesthesia, which can numb a woman from the chest down, produces an especially clear physiological separation of her mind from the body-machine that produces the baby. This message is intensified by the external electronic fetal monitor, attached to her body by a large belt strapped around her waist to monitor the strength of her contractions and the baby's heartbeat.

As the moment of birth approaches, there is an intensification of actions performed on the woman, as she is transferred to a delivery room, placed in the lithotomy position, covered with sterile sheets and doused with antiseptic, and an episiotomy is cut to widen her vaginal opening. These procedures cumulatively make the birthing woman's body the stage on which the drama of society's production of its new member is played out, with the obstetrician as both the director and the star”

We can be thankful that many of these practices have evolved since then and most women’s experience of birth is much more humane. One thing that hasn’t changed is the focus on the all the machines that monitor our birth and make sure we are OK, even though nurse-midwives are widely available. The bed in a hospital labour and delivery unit stands proudly at its centre. In most hospitals, nurses provide the bulk of labour care mothers receive, the doctor, the hero, steps’ in for the final solo. He is the star of the show as the baby crowns, he catches the baby, thrusts her onto her mothers chest, and leaves the room.

Women today have lost their agency in their childbirth experience. Sargent and Bascope (1996) provide a comparative analysis of birth in the three cultures, two in hospitals (one in Jamaca and one in Texas) and a homebirth practice among the Maya in Yaxuna, Mexico. It is this latter group that draws an interesting comparison to the “ritual” of birth in America as described by Davis-Floyd.

Sargent and Bascope introduce us to a lay midwife (Dona Lila) and give us a very different view of agency and knowledge over birth. Dona Lila is a traditional midwife who is trusted by her community because of her experience through attending births. Her knowledge is observational and every woman in the village, more or less, has control over the same information of how birth happens. Dona Lila is set aside because of her privileged knowledge on cord-cutting and the use of pitocin for labour stimulation.

In this community, knowledge about birth is shared by women through their mutual experiences. A mother who has given birth repeatedly is considered to be as knowledgeable as the midwife and has autonomy over her birth. The midwife is there to perform a few procedures that are considered her domain or require special knowledge. Conversely, a mother who is birthing for the first time receives many more interventions and active management of her labour, including considerable fundal pressure, manual stretching of her cervix, and the use of pitocin to augment her labour (Sargent and Bascope, 1996).

Though both first time and more experienced mothers give birth in a traditional position, seated on a hammock with the midwife in front to receive the baby, mothers birthing for the first time receive many more interventions and active management of her labor than mothers who have birthed repeatedly. We can see how a woman’s knowledge of birth influences how she is treated, even among “traditional” societies[ii].

The comparison between the birth experiences of Mayan mothers and the ritual of American birth, as described by Davis-Floyd is important insomuch as woman in this Mayan village gain agency over future births by being initiated through their first birth. American women tend to have repeat experiences without much differentiation by hospital staff between the number of children the patient has birthed. Each mother’s experiential knowledge of birth is minimized and diminished below that of the physician. Martin (2003) confirms this however, she identifies that working-class women were more likely to make changes in subsequent births how their birth was managed, compared to women of higher social standing.

Positions in Childbirth

So how have women given birth historically and in different cultures?

A question arises regarding whether women birth the same today as their sisters of the past, and around the world. We all our influenced by our culture, but did ancient societies protect the culture of birth? Were their technologies of gender different than ours?

In 1884, George J. Engelmann publishedLabor Among Primitive Peoples. This is a thorough account of all the knowledge that we, as a modern society, had learned, culminating in the current obstetric practices of Engelmann’s time. It contains all the previously catalogued birthways of indigenous cultures or “primitive peoples”.

Engelmann documents the parturition, birth, and management of the third stage as observed in cultures from all around the world.

“…I had entered upon the study of the posture occupied during labor by the women of other people, I found a great variety in their customs; but it soon became evident, and impressed itself forcibly upon my mind, that therecumbentposition in labor is rarely assumed among those people who live naturally and are, as yet, governed by their instincts and have escaped the influence of civilization and of modern obstetrics. It certainly appeared as if the ordinary obstetric position of to-day must be an unnatural one…”

He classified the birth positions he observed into the following:

A. Perpendicular:

1. Standing

2. Partially suspended.

3. Suspended.

B. Inclined:

1. Sitting erect on stool, cushion, or stone.

2. Squatting, as in defecation.

3. Kneeling.

(a.) With the body inclined forward, and resting on a chair or staff.

(b.) Knee-elbow position, knee-breast, or knees and hands.

(c.) With the body erect or inclined backwards.

(d.) Not definitely described.

4. Semi-recumbent.

(a.) Sitting semi-recumbent on the ground, a stone, or stool.

(b.) On the lap or between the thighs of an assistant who is seated on a chair or on the floor.

(c.) The obstetric chair.

(d.) Semi-recumbent positions, strictly speaking.

C. Horizontal or recumbent:

(a.) On the back.

(b.) On the side

(c.) On the chest and stomach.

In 1966, the British Medical Journal documented at least forty different postures women have adopted to give birth across various cultures. The author gives us points of considerations for optimal positions in labour which include: comfort of the mother, a position that does not impair the dilation of the cervix or expulsion of the baby, reduction to minimize harm to baby and mother, and lastly, ease of access by birth attendants.

PERPENDICULAR OR UPRIGHT POSTURE

Standing - common in Eastern, in India and parts of Africa.

Brulé Sioux.
Standing

The standing posture may increase the risk of hemorrhage, prolapse of the uterus, and rupture of the perineum.

Most often a strong person supports a mother from behind and holds their arms, while others hold the separated legs, and the midwife can sit comfortably in front.

A variation seen amongst the groups along the eastern coast of India and in the vicinity of Madras, are delivered in an erect, standing posture, supported by an assistant under each shoulder.

Partially suspended

This can be seen to occur in a variety of ways, including the woman hangs on the neckof a husband or friend, swing themselves by a rope from the branch of a tree, or are tied up until the act is over, as if undergoing “punishment”.

Suspended

Engelmann provides several examples, including hanging on to the limb of a tree (Africa), hanging to a cross-bar (Finland), in Brazil, the parturient woman occasionally has her arms tied to a tree while she is waited on by some “old hags” until the delivery is completed.

INCLINED POSITIONS

Engelmann (1884) notes that this position for birthing is the most common among “civilized and savage” people, in both ancient and modern times.

The erect, sitting posture.

The pelvic axis is more inclined than in the standing posture. Englemann notes that women in this position make use of cushions, stones, stools, or “mother earth herself”; but the temptation to assume a somewhat reclining position, leaning against the assistant or some other support, that quite often women assume a somewhat reclining position.

The squatting position

Squatting

Posture

of the

Tonkawas.

Though apparently inconvenient, and repugnant to the refined woman, this position is certainly the most natural one for expulsion from the abdominal or pelvic viscera, and will certainly, in many cases, facilitate labor.

The Irish were identified as also using this natural position, although the knee-elbow position is more common among them. Englemann notes a story where a poor Irish woman was found in a vacant lot in New York city, squatting on the ground, birthing her placenta, having already been delivered her baby in the same position.

Variations:

“during the first stages oflabor the woman is in a stooping posture, with the buttocks resting on the heels. An assistant places herself back of the patient, clasping her body with her arms, letting the fingers reach below the ribs over the base of the uterus, making steady pressure backwards and outwards during the pains. During the third stage, or expulsion of the child, the patient, however, lies down indifferently on eitherside or on the back, while the pressure by the hands of the assistant is kept up continuously, if on the side; if on the back, the assistant remains by the side of the patient and keeps up the pressure in the before-mentioned directions.” In Mexico, they “sometimes suspend a cord from the ceiling, with a stick attached, so that the women can seize it in a half-upright, squatting position” The Zuñi women of New Mexico are delivered in this same position, which we may call a squatting one, and which is described to me as “half standing and half sitting;'' an attendant supports the patient, and facilitates expulsion by pressing the abdomen from above downward.

The kneeling posture and its modifications

Southern Negress.

·Hands and Knees.· The body inclined forward.·This position overdone; that is, with the body throwncompletely forward, the patient resting on the hands and knees, or knees and elbows.

Position for

Delivery

of very Fat

Women

·The body is erect or inclined backward, sometimes clinging to a rope.· Kneeling postures, where precise descriptions are lacking.

Kneeling has been referred to in the Bible as well as by the Roman poets. Englemann notes that kneeling was taught in ancient Rome, among the Arabs, and in Germany during the Middle Ages, and that there were definitive rules for the circumstances under which kneeling should be resorted to, suggesting that it was reserved for complications of birth, not normal birth. However, Englemann remarks that it is one of the most universal positions among Native Americans.

There are advantages and disadvantages to this position in that it is physiologically correct, and “appears most practically to favor the expulsion of the child”, however, it may increase the risk of hemorrhage.

Semi-Recumbent

Favorite Posture of the French Canadian

The semi-recumbent positions are by far the most frequent among ancient cultures, especially among what Englemann calls “the more civilized people” of olden times. However, it is also a documented position used among many indigenous cultures of the present day.

A semi-recumbent position can be achieved in very different ways, and while there may be almost no resemblance in the method of delivery, the position of the body, the inclination of the trunk and the pelvic axis, together with the relaxed position of the thighs, are nearly identical.

Kaffir Woman in Labor

In the position seen among the Kaffir a woman has full power to bear down and assist her pains. However, in this position, no support can be given to the perineum, Englemann suggests that there must be some “support given to the perineum from its resting on the firm floor of the hut, and the sudden passage of the child's head is thereby prevented.''

The simplest of the semi-recumbent positions may be where a mother is sitting on the ground, on a stone or cushion, with her body inclined backward, leaning against an assistant, a tree, or some other object.

Oronoko Indian.

Seated semi-recumbent

in hammock.

Alternatively, a woman may be seated in the lap of an assistant reclining against their chest. Englemann argues that the position reaches its greatest perfection in the obstetric chair.

HORIZONTAL OR RECUMBENT

Typical obstetrical position. Engelmann admits:

“not until I had undertaken this work, and had begun to study the positions assumed by savage and civilized people during labor, that I began to understand that there was a method in the instinctive movements of women in the last stage of labor. I had seen them toss about, and sought to quiet them; I bade them have patience, and lie still upon their backs; but, since entering upon this study, I have learned to look upon their movements in a very different light. I have watched them with interest and profit, and believe that I have learned to understand them. It has often appeared to me, as I sat watching a tedious labor case, how unnatural was the ordinary obstetric position for one parturient woman; the child is forced, I may say, upwards through the pelvic canal in the face of gravity, which acts in the intervals between the pains, and permits the presenting part of the child to sink back again, down the inclined canal. If we look upon the structure of the pelvis,more especially the direction of the pelvic canal and its axis, if we take into consideration the assistance which may be rendered by gravity, and, above all, by the abdominal muscles, the present obstetric position seems indeed a peculiar one.”

Where are we going?

Engelmann’s observation reflects the nature of a woman unencumbered by our technologies of gender that prevents us from trusting our instincts and birthing in the positions, moving the way, and making the sounds that aid in the birth our children.

Above is only a brief synopsis of the more than 62 positions that have been described throughout history and throughout the various regions, cultures and groups of people that have inhabited earth. We, as midwives, need not learn all these positions, but be aware of the breadth that exists. Not inhibit a woman’s movements in labour and instead be there for her, ready to receive or aid in her or her partner receiving their baby for the first time.

As early as the 19th Century, Engelmann identifies the unnatural state of the obstetric mode of delivery. That it’s only purpose is to facilitate the comfort of those attending a birthing woman, to the detriment of the process. He repeatedly highlights the practicality of traditional birthing positions, despite their crude or primitive nature, over the modern obstetric lithotomy position. Engelmann, in 1884 recognized that women in civilized society were bound by their technologies of birth that were engrained in them to be refined and proper. He saw not only the futility of this, but how these restrictions on women actually impeded the birth process, making it more difficult. He offers antidotes of how lay midwives have measures to aid women in emergencies, that it wasn’t always safe and prolapse of the uterus, for example, was common, yet manageable. The practices of these women, birthing with freedom, prevented many hemorrhages, because within themselves knew if a position was not working, when to change. They worked within themselves, within their environment to birth.

Engelmann’s ethnography of birth is worth reading. He is eloquent in his humble regard for ‘primitive’ woman and their strength compared to the ‘weak civilized’ women who have become reliant on, as Robbie Davis-Floyd puts it, the technological mode of birth, 19th C style.

We, as midwives, should aid women to break free of our technology of gender, which may be repressing our abilities as woman to birth without the aid of obstetric interventions and inventions.

This is not to be a judgment on women and families who give birth in hospitals. Hospitals serve a purpose and have become normalized within Western society. What we can, and should, do is challenge our community’s reliance, dependence and execution of birth in these facilities in hopes of making them a space that can facilitate birth in a way that empowers women. A space that makes the woman the centre of attention and aids them in finding within themselves what they need to birth their child, rather than looking to others, wanting to please others, fearing that she did not do her job as well as everyone expected. This should be our goal within our own practices, even within a woman’s home.

[i]“Internalized technologies of gender discipline us from the inside out. They produce who we are, even during seemingly natural experiences like birth. Foucault's notion of technologies of the self allows us a sharper understanding of these gendered ways of being by showing us how they discipline and control from the inside, how they compel us to act in gendered ways from within” (Martin, 2003).

[ii]We may question the use of the term “traditional society” here. Dona Lila had exposure to a pharmaceutical salesman who touted the effectiveness of pitocin, which the community readily accepted as it fit within their pre-existing understanding of birth, that the quicker it was over, the safer it was.

* Images are from Engelmann's 19th C ethnography and were reprinted here from the University of Virgina, with many thanks.

Saturday, June 4, 2011

i have never labelled myself a feminist. i have never felt the need and enjoyed the reaction i would get from people when i said this. especially feminist men.

growing up in anthropology. studying an engendered perspective of human history through archaeology, does not usually equate to a woman who does not identify as a feminist.

i grew up in a relatively safe community. i hated high school. never thought much of myself. somewhat abused by men growing up. all of which i allowed. potentially sought out. i never really stood up for myself.

most people today would see me as strong. independent. opinionated. an intrepid explorer, who rode for 50 hours in a vegetable truck with two Moroccan/Berber men through the western sahara, fearlessly.

they probably see me as a feminist.

i recently came across this article about SlutWalkToronto on Facebook and have not stopped thinking analyzing and reformulating my identity.

I haven't stopped having conversations with people about it.

The author of the article is a "traditional" feminist (excuse my ignorance of the variety of feminist labels).
SlutWalk is some sort of third wave post feminism, that as far as i can see are comprised of women who want to embrace their sexuality.

now in no way am i criticizing a woman's right to be sexy, but from what i am understanding, participants of SlutWalk are diminishing women who do not want to doll-up, call themselves sluts and walk over men. this may be a harsh and grilled down analysis, but there seems to be a lot of disconnection between these groups.

this is where i am lost. why are women calling each other disempowered because of differing few points? i don't see the value in attacking each other.

in my discussions with people on SlutWalk's "taking back" the work slut and claiming it as their own, the value in women identifying their power within their sexuality is questioned.

ok. stop. i have to say i like to feel sexy. i pluck my eye brows, i wear make-up, cute shoes, dresses. i can be a girl, dare i say WOMAN by societies stereotype and i can feel good in this role. there is nothing wrong with that. but i can go weeks without shaving my legs/armpits, i use natural deodorant my sister and i made on my stovetop. i don't manicure my yoni. well, maybe sometimes i'll trim, sometimes i'll shave. but to be honest, the shaving is because i would feel uncomfortable in a bathing suit. i know i'd be judged. not because i really think it needs to be done.

this is kinda important. it's been ingrained on me, on me as a woman, that i have to be hairless to be sexy, or really even to be considered to have good hygiene.

this is where i have claimed my place as a feminist.

beauty fades. intelligence and self respect for being comfortable in your own skin, no matter what that looks like, lasts forever.

what does my feminism look like?

men and women are equally oppressed, by the "man"

our world is not solely a dichotomy of man/woman. there are children and grandparents and genders that represent all colours of the rainbow.

we have to stop fighting each other and look at who really has the power over us. government, business. healthcare.

Becoming a midwife may be an innately feminist profession, but i don't see it as solely protecting the rights of women. families choose to birth at home (or out of hospital). a midwife protects and serves the familial unit, she may fundamental support the woman in all her decisions and needs, but that doesn't have to mean to the exclusion of "men". it might look that way in some cases, but not all.

I first met one of my best friends Jamie when her and her partner Peter came into our practice, transferring late to care after realizing bringing their child into this world with an OB in a hospital was not the right thing for them to do. they had some pretty crap experiences in that pregnancy. THEY DID.

at the first appointment Shell held the doppler to Jamie's 38 week beautiful life giving belly. the room was silent and through the doppler was the strong beat of Ollie. Peter held Jamie's hand and cried. I cried. It was one of the most beautiful moments in my life. this wasn't just about jamie and her empowerment by birthing on her own, it was about sharing that experience with her partner. i think peter became empowered through that birth.

if that is not a feminist belief, then well, think what you want of me. i'm comfortable with all the manifestations of my self that i may express. changing. day to day.

midwife in training

I was brought to midwifery through a series of events that collided and made sense. Was it a calling? I don't know. But it is something that I feel compelled to do, as a service to my community, for my sisters.